Healthcare Provider Details

I. General information

NPI: 1275646895
Provider Name (Legal Business Name): SPECK ORTHODONTICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5335 EDLOE
HOUSTON TX
77005
US

IV. Provider business mailing address

5335 EDLOE
HOUSTON TX
77005
US

V. Phone/Fax

Practice location:
  • Phone: 713-668-6778
  • Fax: 713-668-0702
Mailing address:
  • Phone: 713-668-6778
  • Fax: 713-668-0702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4683
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12153
License Number StateTX

VIII. Authorized Official

Name: DON T SPECK
Title or Position: PRESIDENT
Credential: DDS
Phone: 713-668-6778